How Does Rheumatoid Arthritis Affect Your Lungs

An Immune System Weakened By Ra Treatments

When I was diagnosed and started the immunosuppressant medications, mostly Orencia, my sinus infections came back full force. If I was lucky, I only felt pressure in my head for a few days before the issue corrected itself . If I was unlucky, I got the gamut of symptoms and took antibiotics.

Over the last eight years, Ive been relatively lucky only relying on antibiotics but starting this Fall 2018 I ran into a problem. I began to feel constant pressure in my head. My nose dripped continuously and occasionally Id get the acute infection. Initially, I thought Id just take the antibiotics but they didnt help. It wasnt until my balance was affected that I saw a new doctor.

I had a CT scan . I have an acute infection and it turns out a slightly deviated septum. It is almost completely straight which on its own wouldnt be an issue except the turbinate bones are inflamed and the left one is pushing against my septum. This is causing a mild blockage that is impeding my breathing and draining abilities. Adding a tiny bit of fuel to the fire is my nasal cartilage is weak and collapses every time I breathe.

Well, I guess it wasnt just my chronic sinusitis. I just dont have the anatomy to keep myself healthy!

I am on antibiotics and a steroid nasal spray. I irrigate my sinuses twice a day. I am all set to have a balloon dilation. Later , I hope to get the septum repaired, along with treating the turbinate bones and adding a little support to the cartilage.

Heart And Blood Vessel Disease

Pericarditis, or inflammation of the membrane that surrounds your heart, usually develops during flares. Flares are times when your RA is worse.

If it happens a lot, pericarditis can make the membrane thicker and tighter. That can interfere with your heart’s ability to work the way it should.

Rheumatoid nodules can also form on the heart and affect the way it works.

Inflammation of the heart muscle itself, called myocarditis, is a rare complication.

Rheumatoid arthritis can make you more likely to get cardiovascular disease. It also raises your risk of stroke. This is probably related to long-term inflammation.

Heart disease doesn’t always have symptoms before a crisis. Your doctor can spot some problems during a checkup and may recommend lifestyle changes or medication.

How Rheumatoid Arthritis Affects More Than Joints

Learn more about how the inflammation associated with RA can impact organs and systems beyond the joints.

Arthritis can cause painful, swollen knees or fingers that are impossible to ignore. But other parts of the body, including the skin, eyes and lungs can also be affected. Rheumatoid arthritis is a systemic disease, meaning it can affect many parts of the body.

In addition, the drugs used to treat RA can also cause health problems. Many of these problems such as bone thinning or changes in kidney function cause no immediate symptoms so your doctor may monitor you through lab tests or checkups. For other problems such as skin rashes or dry mouth its important to report any symptoms to your doctor, who can determine the cause, and adjust your treatments accordingly.

Its important to be aware of the affected areas of the body and side effects you may experience. This way, early aggressive treatment can help you avoid RA-related health issues.

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Complications Of Rheumatoid Arthritis: Everything Seems Connected To It

Its hard to believe sometimes but I did have health concerns prior to it! Around the age of 16, I presented with an acute sinus infection that never went away. I was soon diagnosed with chronic sinusitis. I became one of the lucky few whose sinuses never drained properly after a runny nose.

My junior year of high school was especially bad. Every single one of my sinuses filled up and remained full for weeks to months. I missed school because of the intense pain, light sensitivity, and constant pressure.

I was too young for surgery so I got by on antibiotics and steroids for months at a time. Eventually, I was able to have the balloon dilation to open the sinuses and nasal passages, a slight scraping and some other procedures which I dont remember. And they fixed the problem.

For the first time, I wasnt congested, I could breathe properly, I was not in pain and my nose didnt drip! It was magic. .

People With Rheumatoid Arthritis Have A Higher Risk Of Developing Infections

People with RA are more susceptible to infections because of the disease itself and increased vulnerability from medications.

The drugs used for treating RA, including methotrexate, an injectable drug that suppresses inflammation in order to reduce joint pain, can cause a defect in white blood cells which helps fight infection and foreign invaders in our bodies.

As well as this, people who have had surgery on joints such as hip replacements or surgeries may need extended time off work due to their impaired ability to move around without causing further damage whilst recovering making them less likely to be able to keep themselves clean and healthy.

The risk is also higher if you smoke tobacco products also increases the likelihood of developing infections.

There are other treatments available including steroids that do not affect your immune system or even stopping some medication altogether.

It is important to visit the doctor if you are experiencing swollen joints, flu symptoms, or fever.

The most common infections that people with RA can develop include:

• Pneumonia
• Lung abscesses caused by bacteria and tuberculosis all of which can be fatal as your immune system becomes so weakened it cannot fight off these types of diseases.
• People with rheumatoid arthritis have an increased risk of developing infections because inflammation may damage white blood cells.

Fortunately, these types of infections also respond well to antibiotics.

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Pulmonary Manifestations Of Rheumatoid Arthritis

Stomach Pain Or Indigestion

RA and medicines used to treat it are linked to mouth and stomach ulcers, stomach bleeding, acid reflux, diarrhea, and constipation. Painful diverticulitis and colitis are also possible if you have RA.

RA drugs like NSAIDs often cause ulcers or an upset stomach.

Belly pain is sometimes a sign of a rare RA complication called rheumatoid vasculitis when inflammation spreads to your blood vessels. Weight loss and lack of appetite are other symptoms. Vasculitis is serious, so see a doctor right away. Learn more about vasculitis symptoms and types.

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Limit Your Exposure To Pollutants And Chemicals

There are various chemicals and pollutants in the air that increase the oxidative stress in the body, causing inflammation which, in case of RA, is detrimental both for your joints and lungs. Thats why, patients with RA should limit their exposure to pesticides, airborne chemicals, pollutants and more.

What Is The Average Ra Life Expectancy

Studies have found an association between RA and a shortened lifespan. This is different than saying that RA itself causes a premature death. The complications that develop as a result of an aggressive RA disease course are what put patients at a greater risk for a lower life expectancy.

An exact life expectancy is almost impossible to predict due to the varying nature of the disease. In general, patients can expect that the rheumatoid arthritis life expectancy could be shortened by roughly 10 years to as many as 15 years. This is dependent on a number of factors including but not limited to:

• Gender
• Personal and family medical history
• Lifestyle
• Overall levels of health and wellbeing

Do not lose hope! Despite these study results, its also important to note that many RA patients live well into their 80s and 90s which is an average expected lifespan.

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Types Of Rheumatoid Lung Disease

The most common manifestation of pulmonary disease in rheumatoid arthritis is interstitial lung disease , a condition that causes inflammation and scarring of the lungs. Once lung tissue scars, it no longer functions.

The most frequent forms of interstitial lung disease are usually interstitial pneumonia and nonspecific interstitial pneumonia. Another presentation combines pulmonary fibrosis and emphysema.

Causes Of Rheumatoid Arthritis Ild

When rheumatoid arthritis affects the lungs, this is known as rheumatoid arthritis interstitial lung disease . The risk of developing RA-ILD is greater in smokers and in people with increased blood levels of anti-CCP antibodies, which are associated with rheumatoid arthritis.

Although RA-ILD is more common in people who have had rheumatoid arthritis for a long time, it can occur at the same time as diagnosis of rheumatoid arthritis. A small number of people may experience lung problems before joint symptoms.

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Clinical Relevance Of Ild

Given the disconnect between the high prevalence of ILD as defined in radiographic screening studies and the less frequent mortality directly attributable to it, a variety of clinical phenotypes must exist. One approach to defining specific phenotypes is the pattern of disease seen on surgical lung biopsy. In RA-ILD, cellular inflammatory, fibrosing, and mixed changes are seen, and these pathologic patterns fully overlap with those seen in the idiopathic interstitial pneumonias UIP, fibrosing and cellular NSIP, OP and diffuse alveolar damage, LIP, and desquamative interstitial pneumonia patterns have all been described.

The Effects Of Ra Treatment On Lung Tissue Or The Pleura

In principle, any medication that effectively suppresses the immune driven inflammatory processes that cause RA should also be effective for all manifestations of the disease, in all organs. This is generally true, with many instances in which the early signs of lung or pleural disease on CT scan never progress to the extent that the affected person becomes breathless or develops a cough, because of the effectiveness of the medications they are taking. Nonetheless, when RA lung disease is found to get worse, it can be hard to decide if this is because the existing therapy is not completely effective at suppressing the inflammatory RA process or alternatively because the therapy itself is having a direct toxic effect on the lung or an indirect effect as a consequence of chest infections.

Sulfasalazinehas been associated with a lupus-like syndrome where pleural disease is seen, and also a hypersensitivity eosinophilic pneumonia. These are not common events and are usually reversible after stopping treatment.

Leflunomidehas been associated very infrequently with the development of ILD, particularly in Asian people.

Currently,rituximab,abataceptandmycophenolate mofetilare favoured options over TNFi, partly because of a somewhat lower risk of chest infections.

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What You Need To Know About Ra And Lung Disease

Learn more about how respiratory problems are one of the most serious and common complications of rheumatoid arthritis.

Besides the joints, the inflammatory process that underlies rheumatoid arthritis also affects other parts of the body, including the lungs, skin, eyes, digestive system, heart and blood vessels. RA-related lung complications are the most common extra-articular symptoms of RA and include pulmonary nodules pleural effusion bronchiectasis and interstitial lung disease .In fact, it is estimated that 1 in 10 people with rheumatoid arthritis will develop ILD over the course of their disease, making it as deadly among people with RA as congestive heart failure.

What Is Interstitial Lung Disease?

Interstitial lung disease refers to a group of disorders characterized by inflammation and scarring of the lung tissue. In the case of RA-associated ILD, the scarring is caused when the over-active immune system attacks the lungs. When the scarring builds up over time, breathing becomes difficult, and patients may need lung transplants to regain function.

Risk Factors for Interstitial Lung Disease

The risk of developing lung disease is eight times higher in people with RA than in the general population. However, most people with RA are not affected. Risk factors for ILD include:

Diagnosis of Interstitial Lung Disease

Treatment of Interstitial Lung Disease

How Can You Protect Your Lungs?

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The Role Of Methotrexate In Rheumatoid Arthritis

Much has been made of the association between MTX and RA-ILD over the past few decades. While there is an association with MTX and RA-ILD, it is now known to be coincidental and not causative, with the underlying inflammatory process driving ILD. In short, it is the disease and not the drug that causes RA-ILD.62

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The Importance Of Fibrotic Versus Cellular Lung Disease

The information provided by these pathologic patterns is important in the IIPs, the pattern seen on surgical lung biopsy is the most important predictor of early mortality, with patterns characterized by fibrosis having a worse prognosis than those characterized by cellular disease . The pathologic patterns seen in RA-ILD may also have prognostic significance. Available data have suggested that the outcome of patients with RA-ILD ranges from marginally worse , to similar , or even better than that seen in the IIPs. A recent article by Park and colleagues contains the largest number of well-phenotyped subjects and supports the hypothesis that the prognosis of subjects with collagen vascular disease ILD, and particularly those with CVD-UIP, is better than that of patients with idiopathic UIP . As a subgroup, the RA subjects with ILD also had a better prognosis than those with IPF. However, consistent with data from previous studies , those subjects with RA and with UIP pattern pathology had a survival similar to matched subjects with IPF .

Comparison of the survival curves of all subject groups. CVD-NSIP = nonspecific interstitial pneumonia associated with collagen vascular disease CVD-UIP = usual interstitial pneumonia associated with collagen vascular disease I-NSIP = idiopathic nonspecific interstitial pneumonia UIP = usual interstitial pneumonia. Reprinted by permission from Reference .

Chronic Obstructive Pulmonary Disease

Research published in the journal Arthritis Care & Research suggests people with RA are nearly twice as likely to be hospitalized for chronic obstructive pulmonary disease than the general population. COPD is a chronic inflammatory lung disease that obstructs airflow to the lungs. Researchers note that many of the same markers of inflammation found in rheumatoid arthritis are elevated in COPD.

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With Rheumatoid Arthritis How Often Should I Exercise

Advice from your doctor is always best, so follow that first and foremost. The typical RA sufferer will need range-of-motion exercises to improve their long-term health.

Swimming is a great, low-impact way to exercise your body without intense joint pain. This is especially true with a heated pool. The water makes you feel great while you swim. Here are some steps to help you ease into a regular swimming routine:

• Begin slowly with a few minutes in a heated pool
• Use a kickboard when you first adjust to moving in the water
• Gradually build to a goal of swimming 30 minutes at a time

Stay active with water exercises! Swimming, kayaking, canoeing are all great for people living with RA because they dont put any weight on the joints while exercising.

This makes them an excellent alternative to jogging or other forms of running when dealing with arthritis pain.

Walking is also an excellent way to get some moderate aerobic activity without jarring your body too much especially when alternating between uphill and downhill routes where possible so that one set of muscles doesnt have to work harder than another.

Cycling benefits the respiratory system, and its a great way to get some exercise while chatting with friends.

But biking should be done on level ground because an uneven surface will put more stress on your joints than if you were walking or running.

Exercises that place less strain on the body include:

But there are ways to stay healthy with RA.

Ask Your Doctor About Getting Flu And Pneumonia Vaccines

Have you gotten a flu shot this year? Have you discussed the pheumonia vaccine with your doctor? Preventing infection is better than treating infection, since there may be damage to the lungs. Sparks explains, The flu and pneumonia vaccines are effective and all patients with RA are strongly advised to receive them, particularly if on immunosuppressive medication, which might make them both more susceptible to infection. If infected, it could become more severe.

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Keep A Check On The Progression Of Your Disease

RA is a progressive, degenerative disease which over the years can cause severe damage to your various vital organs, including lungs. To prevent the acute damage that RA can cause, it is important to keep a close check on the progression of the disease. So, watch out for all the signs of rheumatoid arthritis and immediately get in touch with your primary care physician if you experience persistent cough, shortness of breath, fever or any other health complication.

Types Of Pulmonary Involvement

Respiratory symptoms in rheumatoid arthritis can be due to a variety of conditions that affect the parenchyma, pleura, airways or vasculature . Complications may arise directly from rheumatoid arthritis involvement or may occur secondary to immune-modulating medications used to treat rheumatoid arthritis. The majority of respiratory manifestations occur within the first 5years of disease . Respiratory symptoms may precede onset of articular symptoms in 1020% of cases . However, they may be masked by poor functional status from joint disease or chronic inflammation.

Pulmonary manifestations of rheumatoid arthritis

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